Download PDF
CC BY-NC-ND 4.0 · South Asian J Cancer 2023; 12(02): 166-172
DOI: 10.1055/s-0042-1757776
Original Article
Head and Neck Cancer

Incidence and Malignancy Rates in Thyroid Nodules in North-East Indian Population by Bethesda System: A Single Institutional Experience of 3 Years

Suvamoy Chakraborty
1   Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
,
Manu C. Balakrishnan
1   Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
,
Vandana Raphael
2   Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
,
Prachurya Tamuli
1   Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
,
Anuradha Deka
1   Department of Otorhinolaryngology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Zoom Image
Suvamoy Chakraborty

Introduction Goiter is one of the most common conditions encountered clinically (up to 60% of population) with thyroid malignancy being one of the most common endocrine malignancies. The American Thyroid Association has advocated the need for validation of the Bethesda system of fine needle aspiration cytology (FNAC) in each center. The risk of malignancy (ROM) for Bethesda categories in the Indian population is limited.

Objective As there are variations in the effectiveness of FNAC, this study aims to study the role of FNAC in evaluating thyroid nodules, estimating the risk of malignancy in thyroid nodules in the North-East Indian population, and correlating the FNAC findings with HPE (histopathological examination).

Materials and Methods A total of 110 patients with thyroid nodules had visited the Department of Otorhinolaryngology during 2017–2020. Case records were retrieved, out of which only 66 patients had both FNAC and HPE reports. The FNAC of 66 patients were studied.

Statistical Analysis Data were analyzed using STATA V14. Fischer's exact test was used to determine the association of Bethesda system in diagnosing thyroid malignancy. The percentage agreement between the FNAC and HPE was calculated using the Kappa statistics. The diagnostic validity of FNAC in the diagnosis of malignant thyroid nodule was reported.

Results The sensitivity, specificity, PPV, and NPV of FNAC in diagnosing thyroid malignancy were 52%, 94.3%, 89%, and 69% respectively. The risk of malignancy (ROM) for Bethesda I to VI categories in our study was 20%, 25%, 67%, 40%, 78%, and 100% respectively (p-value < 0.001, Fischer's exact test).

Conclusion A specificity of 94.3% and PPV of 89% of FNAC makes it a good reliable tool in ruling in malignancy in our population. The higher ROM in indeterminate categories necessitates the need to consider thyroidectomy with or without intraoperative frozen section analysis in our population. Similar higher ROM has been reported in a few other Indian studies. These findings may suggest an increased ROM for Bethesda categories III and IV in the Indian population; however, the statement needs further validation from large multicentric studies with research to find the reason for the increased risk.

Keywords

biopsy - cytodiagnosis - fine needle - goiter - thyroid neoplasms - thyroid nodule

Note

The article was prepared after obtaining institutional ethics committee approval and in confirmation to the Declaration of Helsinki.




Publication History

Article published online:
02 November 2022

© 2022. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Scott-Brown's Otorhinolaryngology and Head and Neck Surgery. 8th ed. Routledge and CRC Press; 2018: 651-700
    Google Scholar
  • 2 Agarwal S, Jain D. Thyroid cytology in India: contemporary review and meta-analysis. J Pathol Transl Med 2017; 51 (06) 533-547
    CrossrefPubMedGoogle Scholar
  • 3 Gharib H, Goellner JR. Fine-needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med 1993; 118 (04) 282-289
    CrossrefPubMedGoogle Scholar
  • 4 Chakravarthy NS, Chandramohan A, Prabhu AJ. et al. Ultrasound-guided fine-needle aspiration cytology along with clinical and radiological features in predicting thyroid malignancy in nodules ≥ 1 cm. Indian J Endocrinol Metab 2018; 22 (05) 597-604
    CrossrefPubMedGoogle Scholar
  • 5 Upadhyaya P, Dhakal S, Adhikari P, Adhikari B, Khadka D, Niraula SR. Histopathological review of diagnostic categories of the Bethesda system for reporting thyroid cytopathology – an institutional experience of 5 years. J Cytol 2019; 36 (01) 48-52
    CrossrefPubMedGoogle Scholar
  • 6 McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012; 22 (03) 276-282
    CrossrefPubMedGoogle Scholar
  • 7 Al Dawish MA, Robert AA, Muna A. et al. Bethesda system for reporting thyroid cytopathology: a three-year study at a tertiary care referral center in Saudi Arabia. World J Clin Oncol 2017; 8 (02) 151-157
    CrossrefPubMedGoogle Scholar
  • 8 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (03) 209-249
    Google Scholar
  • 9 Thewjitcharoen Y, Butadej S, Nakasatien S. et al. Incidence and malignancy rates classified by The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) - an 8-year tertiary center experience in Thailand. J Clin Transl Endocrinol 2018; 16: 100175
    CrossrefPubMedGoogle Scholar
  • 10 Gautam H, Kumar V, Kanaujia S, Maurya D, Singh S. Clinico-cytoradiological correlation of thyroid surgery in patients with thyroid nodule. Ann Indian Acad Otorhinolaryngol Head Neck Surg 2017; 1 (02) 17
    CrossrefGoogle Scholar
  • 11 Mahajan S, Srinivasan R, Rajwanshi A. et al. Risk of malignancy and risk of neoplasia in the Bethesda indeterminate categories: study on 4,532 thyroid fine-needle aspirations from a single institution in India. Acta Cytol 2017; 61 (02) 103-110
    CrossrefPubMedGoogle Scholar
  • 12 Ali SZ. Thyroid cytopathology: Bethesda and beyond. Acta Cytol 2011; 55 (01) 4-12
    CrossrefPubMedGoogle Scholar
  • 13 Bhartiya R, Mallik M, Kumari N, Prasad BN. Evaluation of thyroid lesions by fine-needle aspiration cytology based on Bethesda system for reporting thyroid cytopathology classification among the population of South Bihar. Indian J Med Paediatr Oncol 2016; 37 (04) 265-270
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Pasha HA, Mughal A, Wasif M, Dhanani R, Haider SA, Abbas SA. The efficacy of Bethesda system for prediction of thyroid malignancies-a 9 year experience from a tertiary center. Iran J Otorhinolaryngol 2021; 33 (117) 209-215
    CrossrefPubMedGoogle Scholar
  • 15 Rout K, Ray CS, Behera SK, Biswal R. A comparative study of FNAC and histopathology of thyroid swellings. Indian J Otolaryngol Head Neck Surg 2011; 63 (04) 370-372
    CrossrefPubMedGoogle Scholar
  • 16 Mincer DL, Jialal I. Hashimoto Thyroiditis. In: StatPearls. StatPearls Publishing; 2021. . Accessed September 15, 2021 at: http://www.ncbi.nlm.nih.gov/books/NBK459262/
    Google Scholar
  • 17 Bahaj AS, Alkaff HH, Melebari BN. et al. Role of fine-needle aspiration cytology in evaluating thyroid nodules. A retrospective study from a tertiary care center of Western region, Saudi Arabia. Saudi Med J 2020; 41 (10) 1098-1103
    CrossrefPubMedGoogle Scholar
  • 18 Chaudhary M, Baisakhiya N, Singh G. Clinicopathological and radiological study of thyroid swelling. Indian J Otolaryngol Head Neck Surg 2019; 71 (Suppl. 01) 893-904
    CrossrefPubMedGoogle Scholar
  • 19 Chirayath SR, Pavithran PV, Abraham N. et al. Prospective study of Bethesda categories III and IV thyroid nodules: outcomes and predictive value of BRAFV600E mutation. Indian J Endocrinol Metab 2019; 23 (03) 278-281
    CrossrefPubMedGoogle Scholar
  • 20 Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 2017; 27 (11) 1341-1346
    CrossrefPubMedGoogle Scholar
  • 21 Zahid A, Shafiq W, Nasir KS. et al. Malignancy rates in thyroid nodules classified as Bethesda categories III and IV; a subcontinent perspective. J Clin Transl Endocrinol 2021; 23: 100250
    CrossrefPubMedGoogle Scholar